March 29, 2013

BMT 101: Conditioning

Two weeks ago I talked all about the process of finding a bone marrow donor. Finding a donor, and knowing that you or your family member has an actual shot at life, is one of the best moments in the entire transplant process. It is such a high to know that someone is willing to give the gift of life.

Unfortunately, that high doesn't last for long as the next steps are some of the hardest on the patient.

So what comes next? Conditioning.

Conditioning is the phase before a bone marrow transplant that prepares the recipient's body for their donor cells.

Basically, conditioning is used to empty the patients "defective" cells so that their body can be filled back up with healthy donor cells.

There are so many different conditioning regimes, all based on the specific diagnosis of the patient. Conditioning typically starts 5-10 days before the actual bone marrow/ stem cell transplant. Recently, there has been a shift to reduced-intensity conditioning regimes. This is easier on the patient as less intense chemotherapy drugs are used. However, our transplant doctors have determined that a myleoablative regime (or intense, high chemo regime) is the best option for CAMT patients such as Kate and Will.

All bone marrow transplant patients receive a "road map" that details the medications they will receive and when it will be given. In the BMT world, days are counted a pre and post transplant. Conditioning obviously occurs pre-BMT and is labeled as day -xx. As of now, Will's roadmap will mimic Kate's which means he will be admitted on day -10 (or 10 days before BMT) and be given medications such as anti seizure drugs to prepare his body to start conditioning chemotherapy on day -9. When we get Will's official road map, I will post it but as of now, he will receive 4 different chemotherapy drugs.

Each of the drugs has specific side effects during the infusion period as well as longer term side effects such as hair loss, skin breakdown, and mucositis. They can also impact major organs such as the kidneys, lungs, liver, and heart. Side effects vary person to person however, in our experience, Campath is by far the worst drug of the mix. Kate had an awful time with Campath and I can honestly say I am dreading Campath infusions more than anything else.

Another aspect of the conditioning period is input verses output. Cytoxan needs to be flushed out of the kidneys within a certain amount of time and the best way to do this is to closely monitor fluid intake and output. That means diaper changes (so diapers can be weight for Is and Os) occur every two hours around the clock in order to aide output if needed.

Obviously there are many more aspects of conditioning; these are just a few of the things I know we will deal with.

The day before transplant (day -1) is typically a day of rest, meaning no chemo is given. Day 0 kicks off the post transplant cocktail of meds as well as the actual receiving of donor cells. We'll talk about all of that next week!

As always, feel free to send me any questions you may have! I struggle to write these posts so that people unfamiliar with the BMT process can follow along - it is so easy for me to get way too technical or detailed as I know way more about the transplant process than I ever hoped I would have to learn!